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The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan

1
Department of Health Policy Science, Graduate School of Medical Science, Yamagata University, Yamagata 990-9585, Japan
2
Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai 980-8575, Japan
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(20), 4016; https://doi.org/10.3390/ijerph16204016
Received: 24 August 2019 / Revised: 16 October 2019 / Accepted: 17 October 2019 / Published: 20 October 2019
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)
This study examined the associations between area-level unemployment rates and lower back pain using large-scale data provided by the Japanese working population. We analyzed data from a nationally representative, repeated, cross-sectional study across three waves from 2010, 2013, and 2016 in 47 Japanese subnational level areas. Workers aged 18–64 years (n = 962,586) were eligible to participate in the study. A multilevel logistic model was used to examine the association between the unemployment rate and lower back pain. The self-report of lower back pain was a dependent variable. The prefecture-level unemployment rate was analyzed as an independent variable, adjusted for individual-level covariates (e.g., gender, age, socioeconomic status). After adjusting for all covariates, the main effect of the prefecture-level unemployment rate was statistically significant: the odds ratio (OR) (95% credible interval (CrI)) was 1.01 (1.002, 1.03). Additionally, the OR (95% CrI) for the interaction between gender and the prefecture-level unemployment rate was 1.02 (1.01, 1.03) indicating that women were more affected by area-level employment status than men. In conclusion, a significant association between the unemployment rate and lower back pain was observed in the Japanese working population. Women were more sensitive to the unemployment rate. View Full-Text
Keywords: unemployment rate; socioeconomic status; education; occupation; Bayesian approach; E-value; spillover effect unemployment rate; socioeconomic status; education; occupation; Bayesian approach; E-value; spillover effect
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Ikeda, T.; Sugiyama, K.; Aida, J.; Tsuboya, T.; Osaka, K. The Contextual Effect of Area-Level Unemployment Rate on Lower Back Pain: A Multilevel Analysis of Three Consecutive Surveys of 962,586 Workers in Japan. Int. J. Environ. Res. Public Health 2019, 16, 4016.

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